Practical Methods to Improve Client Compliance in General Medicine

There is a gap between theoretical knowledge about strategies and the techniques or methods to apply in the practice of the consultation to improve compliance. Within the framework of these strategies, a number of techniques to be used in certain situations can be cited: 1) Assessing readiness to change, importance and confidence; 2) Instruments for decision support; 3) Technique of the "pros and cons"; 4) Auto-monitoring techniques; 5) Technique of "information exchange"; 6) Feedback technique; 7) Brainstorming; 8) The “typical day”; and 9) Practical reminder systems for taking medication. A certain technique is not a universal procedure, but it is usually refined by trial and error, based on past experiences, and their choice and design are the responsibility of the general practitioner. DOI: 10.14302/issn.2692-5257.ijgp-20-3164 Corresponding author: Jose Luis Turabian, Health Center Santa Maria de Benquerencia Toledo, Spain, E-mail: jturabianf@hotmail.com


Introduction
Several terms associated with the concept of adherence to treatment are used: therapeutic alliance, cooperation, compliance, mutuality, and collaboration; among others [1]. This situation indicates that there is no total consensus on its meaning. In addition, terminology currently used in prescription adherence research employing electronic databases lacks consistency [2]. Medication persistence refers to the act of continuing the treatment for the prescribed duration. It may be defined as "the duration of time from initiation to discontinuation of therapy." No overarching term combines these two distinct constructs [3].
By "discontinuity of pharmacological therapy" is meant the interruption of the therapeutic scheme followed by a patient. The discontinuity of the treatment indicates in some way a discontinuity of the doctor-patient relationship. Each type of doctor-patient relationship implies a different relationship with pharmacological treatment; but also, the doctor-drug approach style imposes a doctor-patient relationship [4,5]. However, there is a certain gap between these theoretical knowledge and the techniques or methods or tools to apply in the practice of the consultation to improve compliance. In this scenario, this article, which is a personal view, aims to conceptualize and summarize some of the techniques or methods that can be used in general medicine to improve therapeutic compliance, based on an unsystematic or opportunistic search for information and the author's experience.

Methods
The comments in this article should be  • "The diagnosis / problem are..." • "This does mean for you..." • "I can help you through..." • "Where do you want to start…?" • "What do you know about...?" • "How do you feel about...?" • "What do you have the will to do?"

From Contemplation to Action
Negotiate a plan for action. Explain the options and alternatives and provide specific recommendations, ask for the decision and start negotiating a plan for a test, assess and reinforce the skills and resources to execute the plan, anticipate possible problems and help find solutions, identify and mobilize support: • "Your options are..." • "I recommend..." • "Which option do you choose?" • "How do you want to do it…?" • "What problems could appear…?" • "I'd like to see him again in..."

Practical Methods to Improve Compliance in General Medicine
• "Until the next visit, what will you do?" But, assessing "readiness to change" can be done quickly and even replace the previous method and its questions in the course of the interview, by focusing on the main components of "readiness to change", the importance that the patient attaches to the problem of health and compliance, and the patient's confidence in achieving compliance.
In this way, the "stages of change" can be seen as a conjunction of the patient's assessment of the "importance" of the intervention, and their "confidence" in their ability to make the changes that the intervention requires. This is clinically important as it can help the GP to direct his interventions to the needs of the patients.
There may be patients who prefer to discuss more about the importance of the intervention, and others who are more interested in the aspect of their confidence in their ability to achieve it effectively. Thus, there may be patients who feel confident in their ability to achieve compliance, but doubt the importance of therapeutic intervention (for example, whether it is time to start with anti-hypertensive medication); and vice versa, patients who are clear about the importance of therapeutic intervention (for example, anticoagulation to prevent a stroke), but hesitate to accept it because they are not confident that they can comply with the treatment [1].

In this way, it can be Asked
• How important is it to take the medicine?
• What would you need to increase your assessment of the importance of taking the medication?
The patient may express doubts and errors about the medication, such as sexual function impairment, or other possible ADRs: • Do you think it will be difficult to comply with the treatment?
• What would you need to increase your assessment of your confidence in complying with taking the medication?
The patient may express, for example, that since he has a bad memory, it will be difficult for him to comply with the therapeutic regimen as prescribed [1].  [20]. The choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess [21][22][23][24].

Technique of the "Pros and Cons"
Physicians who routinely involve their patients in treatment decisions (presenting options, discussing the pros and cons of the options, exploring patient preferences, and reaching jointly agreed treatment plans), are classified as having participatory style or that allow shared decisions. These professionals tend to be more successful in providing patient safety, and as a result, they obtain better health outcomes than non-participatory doctors [25,26].
To helping the patient to think clearly, one suggestion is to write or to think about the arguments for and against, as do it Daniel Defoe in the novel "Robinson Crusoe" or as Stevenson in "The wrong